Cesarean Section and Its Correlates Among Early Child Bearing Women in Nepal

Abstract

Background: Cesarean section (CS) is an important indicator of accessibility to emergency obstetric care. In Nepal there is a high rate of early marriage leading to increase in teen age pregnancy however, the factors associated with CS among early child bearing women remains unreported. Hence, the objective of this study is to examine the factors associated with CS among early child bearing women. Methods: We used the 2016 National Demographic and Health Survey (NDHS) data obtained from DHS department of USAID for this study. Bivariable analysis was done using chi square test. We used logistic regression model to identify the factors associated with CS among early child bearing women. Results: Out of 4006 women of reproductive age group from 1996 to 2016, more than 50% had early pregnancy. The population-based cesarean section (CS) rate was about 10% [95% confidence interval: (8.9-11.6)]. Our logistic regression model showed that women with early child bearing had 32% (p-value <0.05, 95% confidence interval: 0.50- 0.94) less chance of having CS than women of age group 19-29 years. It was also evident that poorest women of same age group had 66% less likelihood of having CS than the richest (p-value: <0.05, 95% confidence interval: 0.29-0.99). Similarly, women from province-1, province-3 and province-4, having complete four antenatal check-ups and delivering in a private institution were associated with CS among early child bearers. Conclusion: The odds of having CS decreased by 66% among women with early pregnancy than their counterparts after adjusting for all other covariates. This suggests that the early pregnancy might not be the risk factor for having a CS. However, we also found that this relationship might have been confounded by the interaction between wealth index and age groups as there was a huge disparity in CS rate among poorest and wealthiest women who had early child bearing. Thus, Nepal government should focus more on providing adequate accessibility to CS services throughout the population so that every woman could utilize the services in need.